PB2284: EPIDEMIOLOGICAL, CLINICAL AND THERAPEUTIC ASPECT OF INDOLENT LYMPHOMAS IN TUNISIA
Authors: Ons Charef, Sarra Boukhriss, Yasmine Bnouni, Zaineb Mlayah, Wiem Boufrikha, Slama Nader, Adnene Laatiri
Journal: HemaSphere (2023)

Topic: 18. Indolent and mantle-cell non-Hodgkin lymphoma - Clinical Background: Indolent lymphomas represent approximately one-third of all non-Hodgkin lymphomas, with an ever-increasing number of survivors. Despite the indolent course, patients are subject to repeated relapses and remissions, and exposed to a recurrent need for treatment and intervention. To date, there is no consensus on the optimal management of indolent lymphomas, but over the last ten years, several therapeutic innovations have been proposed for the treatment of these lymphomas, and since then, no evaluation has been made in our department for this type of hematological malignancy. Aims: The aim of our study is the description of the epidemiological, diagnostic, evolutionary and prognostic characteristics of indolent lymphomas and the treatment strategy in patients treated in the haematology department at the Fattouma Bourguiba University Hospital in Tunisia. Methods: This is a retrospective study carried on patients diagnosed with indolent lymphomas in the clinical hematology department at the Fattouma Bourguiba University Hospital in Tunisia over a 9-year period from 2012 to 2021. Results: Forty-eight patients were included in this study, distributed as follows 15 cases (31%) of follicular lymphoma (FL), 12 cases (25%) of MALT lymphoma,8 cases (17%)of marginal zone lymphoma (splenic + nodal) (MZL), 10 cases(21%) of mantle cell lymphoma (MCL) and 3 cases (6%)of lymphocytic lymphoma (LL). The median age was 56 years (range 26 – 79 years), with 39% of patients older than 60 years of age. Sex- ratio was 1.6. The average time to diagnosis was 3 months. The main reason for consultation was lymphadenopathy (50%) followed by B symptoms was observed in 20% of patients. Poor PS assessed to two or more was noted in 7 patients (15%).The majority of our patients had an extensive stage at diagnosis (69%) contrasting with a preserved general condition. The bone marrow was involved in 29% of cases. IPI and aaIPI were calculated for all patients. 34 (71%) and 26 patients (54%) had low or low intermediate risk according to the IPI and aaIPI respectively. In FL and LL patients, the most frequent treatment regimen was RCHOP. MALT lymphoma patients were treated with RCHOP, RCOP or oral combination of Corsticosteroid and cyclophosphamid. Similarly, patients with MZL was treated with the same regimens and a splenectomy was done in one patient. Whereas MCL received alterned RCHOP/RDHAP or only RCHOP with ASCT for one patient. Two FL patients and one MCL patient did not receive adequate injections of Rituximab due to grade 3 allergy. At end of treatment, the complete or unconfirmed complete response rate was obtained in 69%, while relapse after response occurred in 8 cases (17%).Dix patients (48%) died before the end of the follow-up period. 2 year overall survival was 83%. The influencing factors in the univariate analysis were sex, PS, early evaluation response and end of treatment response. Only sex was retained in the multivariate analysis. 2 year EFS was 61%. Age, LDH level, IPI, extranodal lesions, early response and end of treatment response were significant in the univariate analysis.Whereas only Age, LDH level, extranodal lesions, early response and end of treatment response remained significant in multivariate analysis. Summary/Conclusion: Because of the heterogeneity of this pathology, there is currently no consensus in the management of indolent lymphomas. For this reason, more studies especially multcentric ones are needed in order to analyze each histological subtype separately and set national protocols for indolent lymphomas. Keywords: Indolent lymphoma, Indolent non-Hodgkin’s lymphoma